frozen donor eggs an emerging market and a word to the wise

Now that new freezing techniques have made frozen eggs more viable, doctors and patients are eager to work them, as they offer some time and cost advantages over fresh. However, because a donor egg cycle is so costly, is it not financially practical in most cases for a clinic to do a donor egg cycle on speculation. The costs for the procedures, drugs, and donor compensation are typically more than the selling price of the resulting eggs. So clinics have been working on some creative solutions, which they may enthusiastically pitch to their patients as well as to prospective donors. I would like to make both parties aware of the full implications and motivations of these strategies, so that they can make informed decisions.

DONOR EGG RECIPIENTS: your doctor may encourage you NOT to fertilize all the eggs retrieved from your donor, to avoid the supposed ethical conundrum of left over frozen embryos. I am dubious of this advice, as in my experience, recipients want as many good quality frozen embryos as possible, and would not want to compromise all that time, money, and effort by not fertilizing all their eggs. Any doctor who advises this does not have that state of your conscience in mind: he or she wants to buy any left over frozen eggs from you to sell to his other patients! Most egg donor recipients we work with would rather have frozen embryos than an extra few hundred dollars, although some may appreciate getting some money back. But please be aware: in this scenario, the clinic is having one set of recipients subsidize the stocking of the clinics frozen egg bank, for the clinics own profit and benefit.

EGG DONORS: I have been kicking around this idea for a while: having an egg donor keep a portion of her retrieved eggs in exchange for a reduced compensation. The stumbling block is, as always, financial: the donor needs to make a lot of viable eggs in order to have enough for both the donor and recipient. Therefore the only candidate for this is a repeat donor with a history of making a high number of mature, fertilizable eggs. This cuts the number of candidates to a small percentage; plus, this candidate has to be willing to take a smaller compensation on the gamble that she will need these eggs in the future. And there is no guarantee that these eggs will survive the thaw and produce healthy babies: frozen eggs are not the safety net they are sometimes pitched to be.

Another consideration for egg donors concerns the same issue described above for recipients: by donating to a clinic or through an agency, most donors think they are helping an infertile couple get pregnant. But the clinic may fertilize just a few of the eggs for that couple, and freeze the rest to sell to others (and not just other patients at that clinic, but perhaps other egg banks and resellers anywhere). The American Society for Reproductive Medicine (ASRM) places a supposed ethical limit on the amount of financial compensation a donor can receive for her donation, but no such limit exists for doctors. Some donors may not mind not knowing the destination of their eggs once they are donated, but if this is a concern for a potential donor, the egg donor contract should delineate the proper use of the eggs with as much specificity as possible.

EGG DONOR RECIPIENTS AND EGG DONORS: Frozen eggs can make fertility treatment affordable and easier for some recipients, but it is important to be aware of the financial pressures that shape clinical practice. The fact remains at this point that fresh eggs have better success rates.